Endocarditis Empirical therapy

Prosthetic heart valve infections are usually:

  • Staphylococcal (Coagulase negative / MSSA / MRSA)
  • Enterococcal
Antibiotic Therapy (before prescribing, carefully read the Notes / Comments section below)

Vancomycin IV (dosing info here)

and

Gentamicin* IV (synergistic dosing)

Duration: Review microbiology results at 72 hours and discuss with microbiology / infectious diseases course duration.
Notes / Comments

If Meticillin Sensitive Staphylococcus aureus (MSSA) isolated, switch from IV vancomycin to IV Flucloxacillin 2g 6 hourly if <85kg (or if ≥85kg 2g 4 hourly) unless true penicillin allergy.

*Gentamicin synergistic dosing – for guidance on dose, monitoring and duration see guideline on NHSGGC StaffNet / Clinical Info /  Clinical Guideline Directory (link only active if accessing via NHS computer) and search for 'Synergistic Gentamicin for Endocarditis in Adults'

Discuss with microbiology at 72 hours the need for oral rifampicin:

  • ≤70kg 450mg 12 hourly
  • >70kg 600mg 12 hourly

With rifampicin:

  • Check for drug interactions (BNF Appendix 1).
  • Caution if pre-existing liver disease.
  • Must not be used as monotherapy.

Content last updated January 2021




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